Physician know thyself

Whilst this may be a common interview question, it is important to reflect on ourselves regularly too. As doctors, our personalities have a direct influence on our ability to care for patients, work in teams, and cope with stress. Recognising our weaknesses, and taking conscious steps to minimise the impact they have on others, can improve both our ability to perform as doctors and help prevent burnout.

Being self-critical is a double-edged sword. On the one hand, the ability to honestly critique yourself is invaluable for self-improvement. On the other hand, if pushed too far it can lead to loss of confidence, and so it is important that a balance is struck.

Learning about yourself

How well do we really know ourselves? Most of us can identify some of our strengths and weaknesses, however, often we have personality features which we are not wholly aware of. These features may emerge particularly when we are under pressure, and may be more obvious to others than to ourselves.

Here are some strategies for recognising features of your personality that may be influencing the way you work:

Think about yourself from a different perspective. One approach to self-analysis is to understand that our strengths can also be our weaknesses, and to re-frame them as such for the purpose of reflection. If you’re a perfectionist then you produce amazing work – but it might be slow and inefficient. If you’re a great collaborator you might be terrible at handling conflict. Consider how you can use your strengths and understand your weaknesses to improve your practice and confidence.

Ask for feedback. Ask your team – how are you doing at work, and what can you do better? Your registrar is ideally placed to comment on how you are doing day to day. Consider asking friends and family for their honest opinion on your strengths and weaknesses. Be prepared for some hard-hitting answers – these are often the ones you learn the most from.

Analyse key events. Think about a moment during the week that was particularly stressful and try to break down why you perceived it in that way. Maybe you had a particularly busy day on take and this affected your mood. Why was that? Was it the quantity of work or the nature of the tasks? In a situation where you may not be able to control external factors, recognising your personality tendencies and modulating your response to these external stressors can empower you. If you find it very difficult or distressing to examine stressful events by yourself, then do it with a friend, colleague, or use a free confidential counselling service like the employee assistance program through your hospital.

Test yourself. Quizzes such as the Myer Briggs Type Indicator questionnaire are commonly used and can assess personality traits such as introversion, extraversion, perception and judgement. Note that these are not evidence based, so just have fun and take it with a grain of salt.

Common personality traits of doctors

A number of studies have evaluated the personality traits of doctors. A study of Dutch anaesthesiologists found that neuroticism was the most important factor increasing risk of psychological distress and burnout, whilst extraversion was protective [1]. A study of Japanese residents showed that those with high cooperativeness were significantly more likely to undergo burnout, and those with high harm avoidance and low self-directedness were significantly more prone to depressive states [2]. A survey of 1,178 Canadian physicians found that 53% identified with the term “workaholic”, 62% with having “Type A personality”, and 35% with “control freak” [3].

Three common weaknesses

While there are many unique areas we can each improve upon, there are several common personality traits of doctors, which can represent weaknesses. Let’s talk about three common weaknesses, and some tips from my friends, colleagues and myself on how to target them.

Neuroticism

Neuroticism is one of the most common personality traits in doctors. It can motivate us to work harder, maintain high standards, and achieve goals. The flipside is that neuroticism can make life more stressful than it needs to be, for both you and those around you. An overly neurotic doctor can cause tension and stress within a team, ineffective use of available resources, burnout, and poor patient outcomes. An article from the BMJ on perfectionism suggests some early warning signs [4]: “all or nothing” thinking, micromanaging of team members, failure to delegate, inability to forgive small errors, dissatisfaction with success, procrastination to avoid the possibility of making an error, and relentless striving for achievement without praising others.

What can you do about this? One approach is to make a conscious effort to reduce the impact of your neuroticism on others. If you’re a resident with difficulty delegating to your intern, discuss with them which tasks you would like to delegate and take the time to discuss how they should be done. Accept that so long as the ultimate goal of patient safety is achieved, they do not need to perform the task exactly as you do. Chat to a senior colleague on your team – get an outsider’s perspective on your performance and what you can work on. Remember to think about your strengths too, and give yourself praise for the things you have done well. For more tips on dealing with perfectionism, read this article on The Pressure of Being Perfect in Medicine [6].

Anger

Anger can manifest along a spectrum from full blown loss of temper in the workplace to milder forms, such as impatience and intolerance. Novack et al. suggest that doctors ask themselves the following questions [5]: “what sort of patients elicit an angry reaction in me? What work situations make me angry, and why?”

Anger in the workplace can cause breakdown of interpersonal relationships, emotional distress for peers and patients, poor communication, and physician burnout. Try to recognise common situations at work that make you angry or impatient. Think about what you can do to mitigate, resolve or avoid this situation in the future. For example, if you’ve been abrupt with an intern who’s called you with a consult at a bad time, next time ask him or her to call back in an hour. If the consult was presented poorly, take a minute to place yourself back in an intern’s shoes. This can be easier said than done, and may require you to take a moment and focus on how you fix the situation: teach her or him how to make a better consult, or if you need additional information, ask specifically for the intern to obtain this, and call you back when it is available. If you know there are factors that worsen your mood like poor sleep or lack of caffeine, take extra precautions to avoid these factors and ensure you are in the best frame of mind to work. For more great tips, refer to the article on How to avoid losing your temper at work by Ken Liu [7].

Pride

Pride is a healthy trait in all people – we should all have achievements, skills and qualities to be proud of. However, too much pride can make someone unable to recognise or admit to mistakes, less focused on his or her patients’ best interests, or compromise his integrity in an attempt to maintain a self-image. In a workplace, examples include not asking an important question to your team because you don’t want to appear unknowledgeable, concealing or not admitting to a mistake, or being too proud to ask for emotional support from your peers when life and work stressors are getting you down.

Whilst you should never try to throw pride out the window, you can take steps to make sure your pride does not get in the way of your patient care. The techniques for combatting pride are similar to those for developing self-awareness – seek honest feedback and reflect on your strengths and weaknesses. Chat to your peers about their experiences, and realise that neither you nor anyone else is perfect. Don’t be afraid to show what you don’t know – learn from it. Prioritise your integrity and patient safety over your self-image. Many of the most respected senior doctors are also the most humble.

Avoiding burnout

Whilst this blog focuses on recognising and modifying negative behaviours to reduce stress and burnout [8], remember that there are many other ways in which you can reduce burnout too. Positive self-reinforcement and praise, exercise, healthy eating and sleeping habits, taking time out to socialise with friends and family and participating in much-loved hobbies are all important ways in which you can also improve your mood. This great onthewards article gives more ideas on how to de-stress [9].

Why know thyself?

So why is it so important for doctors to know themselves?

As junior doctors, we work in a health care system with many factors that are beyond our control, such as the volume of work, hospital funding, and availability of jobs. Recognising and targeting the modifiable factors in our lives – including ourselves – can help us reduce stress and increase satisfaction from work, improve our teamwork, and avoid burnout.

Remember that significant changes are never an overnight fix and that there are lots of places to get help; your friends, family, colleagues, a mentor or professional counselling. The first step is to recognise the situations in which certain traits become counterproductive, before pondering ways in which we can get around this. This is a slow, conscious process and there may be some days that you are better at it than others. Nobody is perfect, and so doctors should not be either.

About The Author

Medical Registrar at Royal North Shore Hospital. Linda is passionate about medical education and believes in fostering an open supportive culture for junior doctors. She also has a special interest in endocrinology and related research. Ironically, in her spare time she enjoys baking goods of not unsubstantial calorie content.